- Email: [email protected]
Dysphagia Lusoria due to Abberant Right Subclavian Artery in Twins
MISCELLANEOUS
CONFLICTS OF INTEREST
41
The authors have none to declare.
THROMBOELASTOGRAPHY (TEG) DOES NOT PREDICT THROMBOPHILIA IN HEPATIC VENOUS OUTFLOW TRACT OBSTRUCTION (HVOTO)
Corresponding author: Anshu Srivastava. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.160
Abhinav Jain, Shobna Bhatia, Akash Shukla Seth GSMC & KEMH, Mumbai, India
40
Background: An aberrant right subclavian artery is a common embryological abnormality. Most cases are asymptomatic but may present with dysphagia, that is, dysphagia lusoria. But, dysphagia lusoria has never been reported in twins. We present to you the first case of four year old female twins with dysphagia lusoria. Case Report: Four year old female, monozygotic twins presented with the chief complaints of vomiting immediately on taking solid foods since six months of age. Numerous investigations including indirect and direct laryngoscopy, upper GI endoscopy, esophageal barometry, CT and MRI, echocardiography of both the children were all inconclusive. Lastly, barium esophagogram was done which picked up the vascular anomaly consistent with extrinsic compression by a retro-oesophageal aberrant right subclavian artery. Spot film from barium esophagogram in the other twin sister showed similar findings. They were both operated for resection and reconstructive bypass surgery and are currently doing well. Conclusion: The main objective of this report would be to diagnose this condition with as minimum investigations and radiation exposure as possible. Any beak like posterior esophageal wall indentation on esophagogram unless proven otherwise should be treated as vascular. A good medical history is imperative for timely diagnosis.
Background and Aim: TEG assesses dynamics of clot formation and is reliable for assessing coagulation state in cirrhosis. TEG has been used to assess prothrombotic states. The combination of prothrombotic state and liver dysfunction hampers interpretation of traditional coagulation tests in HVOTO. However, role of TEG in HVOTO remains uninvestigated. We performed TEG in HVOTO patients to predict prothrombotic disorder. Methods: Fifty-four patients with HVOTO (age 32.3 [10.7] years; 29 women) underwent TEG. CI, R-time, K-time, MA and alpha-angle were analysed and correlated with clinical profile and underlying prothrombotic conditions. Patients on anticoagulation/antiplatelet drugs in last 2 weeks were excluded. IEC approval was taken. Results: CI values for Rotterdam Class I, II and III were 1.82 (4.1), 2.29 (7.1) and 1.5 (2.1) respectively (P > 0.05). TEG showed CI > 3 in three; R-time < 1 min in two; K-time < 1 min in two; alpha-angle >78 in none; MA > 69 mm in eight patients. Fifteen patients had CI < 3, while 36 had normal CI. TEG parameters did not differ in patients with underlying thrombophilic conditions (n = 23) and those without (n = 28) (P > 0.05). Mean LY30 was higher in Rotterdam class-III (41.0) than class-I (2.93) and II (3.8); P < 0.01. The mean CI was lower ( 15 vs 1.35; P value < 0.05) and R-time (15.3 vs 6.6; P < 0.05) and Ktime (11.3 vs 2.6; P < 0.05) prolonged in patients with IVC as compared to rest. The sensitivity, specificity, PPV and NPV of TEG to predict thrombophilia were 17.3%, 71.4%, 33.3% and 51.2% respectively. Conclusion: TEG poorly predicted presence of a prothrombotic state in HVOTO. Hyperfibrinolysis and hypo-coagulability were predominant in Rotterdam class-III.
CONFLICTS OF INTEREST
CONFLICTS OF INTEREST
The authors have none to declare.
The authors have none to declare.
Corresponding author: Disha Sharma. E-mail: [email protected]
Corresponding author: Akash Shukla. E-mail: [email protected]
http://dx.doi.org/10.1016/j.jceh.2016.06.161
http://dx.doi.org/10.1016/j.jceh.2016.06.162
DYSPHAGIA LUSORIA DUE TO ABBERANT RIGHT SUBCLAVIAN ARTERY IN TWINS Disha Sharma, Amit Dey Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
Miscellaneous
S96
© 2016, INASL
CONFLICTS OF INTEREST
41
The authors have none to declare.
THROMBOELASTOGRAPHY (TEG) DOES NOT PREDICT THROMBOPHILIA IN HEPATIC VENOUS OUTFLOW TRACT OBSTRUCTION (HVOTO)
Corresponding author: Anshu Srivastava. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.160
Abhinav Jain, Shobna Bhatia, Akash Shukla Seth GSMC & KEMH, Mumbai, India
40
Background: An aberrant right subclavian artery is a common embryological abnormality. Most cases are asymptomatic but may present with dysphagia, that is, dysphagia lusoria. But, dysphagia lusoria has never been reported in twins. We present to you the first case of four year old female twins with dysphagia lusoria. Case Report: Four year old female, monozygotic twins presented with the chief complaints of vomiting immediately on taking solid foods since six months of age. Numerous investigations including indirect and direct laryngoscopy, upper GI endoscopy, esophageal barometry, CT and MRI, echocardiography of both the children were all inconclusive. Lastly, barium esophagogram was done which picked up the vascular anomaly consistent with extrinsic compression by a retro-oesophageal aberrant right subclavian artery. Spot film from barium esophagogram in the other twin sister showed similar findings. They were both operated for resection and reconstructive bypass surgery and are currently doing well. Conclusion: The main objective of this report would be to diagnose this condition with as minimum investigations and radiation exposure as possible. Any beak like posterior esophageal wall indentation on esophagogram unless proven otherwise should be treated as vascular. A good medical history is imperative for timely diagnosis.
Background and Aim: TEG assesses dynamics of clot formation and is reliable for assessing coagulation state in cirrhosis. TEG has been used to assess prothrombotic states. The combination of prothrombotic state and liver dysfunction hampers interpretation of traditional coagulation tests in HVOTO. However, role of TEG in HVOTO remains uninvestigated. We performed TEG in HVOTO patients to predict prothrombotic disorder. Methods: Fifty-four patients with HVOTO (age 32.3 [10.7] years; 29 women) underwent TEG. CI, R-time, K-time, MA and alpha-angle were analysed and correlated with clinical profile and underlying prothrombotic conditions. Patients on anticoagulation/antiplatelet drugs in last 2 weeks were excluded. IEC approval was taken. Results: CI values for Rotterdam Class I, II and III were 1.82 (4.1), 2.29 (7.1) and 1.5 (2.1) respectively (P > 0.05). TEG showed CI > 3 in three; R-time < 1 min in two; K-time < 1 min in two; alpha-angle >78 in none; MA > 69 mm in eight patients. Fifteen patients had CI < 3, while 36 had normal CI. TEG parameters did not differ in patients with underlying thrombophilic conditions (n = 23) and those without (n = 28) (P > 0.05). Mean LY30 was higher in Rotterdam class-III (41.0) than class-I (2.93) and II (3.8); P < 0.01. The mean CI was lower ( 15 vs 1.35; P value < 0.05) and R-time (15.3 vs 6.6; P < 0.05) and Ktime (11.3 vs 2.6; P < 0.05) prolonged in patients with IVC as compared to rest. The sensitivity, specificity, PPV and NPV of TEG to predict thrombophilia were 17.3%, 71.4%, 33.3% and 51.2% respectively. Conclusion: TEG poorly predicted presence of a prothrombotic state in HVOTO. Hyperfibrinolysis and hypo-coagulability were predominant in Rotterdam class-III.
CONFLICTS OF INTEREST
CONFLICTS OF INTEREST
The authors have none to declare.
The authors have none to declare.
Corresponding author: Disha Sharma. E-mail: [email protected]
Corresponding author: Akash Shukla. E-mail: [email protected]
http://dx.doi.org/10.1016/j.jceh.2016.06.161
http://dx.doi.org/10.1016/j.jceh.2016.06.162
DYSPHAGIA LUSORIA DUE TO ABBERANT RIGHT SUBCLAVIAN ARTERY IN TWINS Disha Sharma, Amit Dey Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
Miscellaneous
S96
© 2016, INASL